Dental Insurance Articles
Three Similarities Between A Dental And General Healthcare Hmo Plan
2010-05-15
Healthcare is an important topic in the news and in our daily lives. The economy has made us most careful about how we subscribe to healthcare benefits. We measure and analyze where each healthcare dollar is going. We want to get the best healthcare at an affordable price. When we discuss healthcare, most of us include dental care in our list of concerns. Like a healthcare HMO, dental HMOs have become more common in recent years. They allow us to achieve the same goal as in healthcare - to ensure that we get the most comprehensive level of benefits at the lowest cost. There are three similarities between dental HMOs and healthcare HMOs.
Like a healthcare HMO plan, dental HMOs cap the amount of money we have to pay to receive essential services like preventive care and filling cavities. We have the same key expenses as a healthcare HMO: co-pays, plan fees and out-of-pocket expenses. Part of what we pay the insurance company covers what is called a 'capitation' fee. This is a monthly fee the dentist receives for each insured person who has listed him as the primary care dentist. They receive this fee whether you visit him or not - it is part of his fee for agreeing to the HMO rates and services. A dental HMO limits you to visiting your primary care dentist. You can always change your primary care dentist to another listed under the plan prior to arriving for services.
Dental HMOs have maximum benefits set in the same way as healthcare HMOs. The maximum benefit can be set for a family or for each individual insured in the family. It can also be set by procedure or by total benefits received. This will vary by provider. Be sure to compare the maximum benefits to other plans you may be considering.
The third key similarity is UCR fees - usual, customary and reasonable fees. UCR fees are set for most dental procedures. The doctor is limited to this rate when billing the dental HMO and you cannot be billed for the difference. Healthcare HMOs work similarly. Ask your insurance provider to list out the different rates for preventive and reparative procedures in a dental insurance quote.
These three key similarities help us to be comfortable with the idea of a dental HMO. They help us to understand the pros and cons of a dental HMO plan. Understanding the rates, fees and limitations of a dental HMO before buying is essential. Make sure to compare these to your individual dental needs when considering a dental insurance quotes. A little bit of research tends to go a long way.